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First successful bridge to cardiac transplantation using direct mechanical ventricular actuation.

Publication ,  Journal Article
Lowe, JE; Anstadt, MP; Van Trigt, P; Smith, PK; Hendry, PJ; Plunkett, MD; Anstadt, GL
Published in: Ann Thorac Surg
December 1991

Currently available ventricular assist devices are technically difficult to implant, require continuous anticoagulation, and are associated with hemorrhagic and thromboembolic complications. Direct mechanical ventricular actuation is a biventricular assist device that can be applied in 3 to 5 minutes through a left anterior thoracotomy and has no direct blood contact or need for anticoagulation. The present study was designed to determine the effects of direct mechanical ventricular actuation in total biventricular circulatory support. Cardiogenic shock refractory to standard therapy developed in 2 patients awaiting cardiac transplantation. Direct mechanical ventricular actuation was applied and provided immediate hemodynamic stabilization in both. All inotropic agents and intraaortic balloon support were then discontinued. Fifty-six hours of circulatory support bridged the first patient to successful cardiac transplantation without complication. The patient is alive and well more than 1 year later without incident of infection or rejection. The second patient suffered cardiac arrest and required closed chest cardiopulmonary resuscitation before device application. After 45 hours of support, it was determined that irreversible neurologic injury had occurred and direct mechanical ventricular actuation was discontinued. Neither patient's native heart exhibited any histologic evidence of device-related trauma. Direct mechanical ventricular actuation has undergone limited clinical investigation since its original description 25 years ago, but in these initial trials, the device has proved effective. The concept of mechanically actuating the ventricles appears to be a valuable, yet under-utilized method of total circulatory support.

Duke Scholars

Published In

Ann Thorac Surg

DOI

ISSN

0003-4975

Publication Date

December 1991

Volume

52

Issue

6

Start / End Page

1237 / 1243

Location

Netherlands

Related Subject Headings

  • Shock, Cardiogenic
  • Respiratory System
  • Myocardium
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Humans
  • Heart-Assist Devices
  • Heart Transplantation
  • Heart Failure
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Lowe, J. E., Anstadt, M. P., Van Trigt, P., Smith, P. K., Hendry, P. J., Plunkett, M. D., & Anstadt, G. L. (1991). First successful bridge to cardiac transplantation using direct mechanical ventricular actuation. Ann Thorac Surg, 52(6), 1237–1243. https://doi.org/10.1016/0003-4975(91)90007-d
Lowe, J. E., M. P. Anstadt, P. Van Trigt, P. K. Smith, P. J. Hendry, M. D. Plunkett, and G. L. Anstadt. “First successful bridge to cardiac transplantation using direct mechanical ventricular actuation.Ann Thorac Surg 52, no. 6 (December 1991): 1237–43. https://doi.org/10.1016/0003-4975(91)90007-d.
Lowe JE, Anstadt MP, Van Trigt P, Smith PK, Hendry PJ, Plunkett MD, et al. First successful bridge to cardiac transplantation using direct mechanical ventricular actuation. Ann Thorac Surg. 1991 Dec;52(6):1237–43.
Lowe, J. E., et al. “First successful bridge to cardiac transplantation using direct mechanical ventricular actuation.Ann Thorac Surg, vol. 52, no. 6, Dec. 1991, pp. 1237–43. Pubmed, doi:10.1016/0003-4975(91)90007-d.
Lowe JE, Anstadt MP, Van Trigt P, Smith PK, Hendry PJ, Plunkett MD, Anstadt GL. First successful bridge to cardiac transplantation using direct mechanical ventricular actuation. Ann Thorac Surg. 1991 Dec;52(6):1237–1243.
Journal cover image

Published In

Ann Thorac Surg

DOI

ISSN

0003-4975

Publication Date

December 1991

Volume

52

Issue

6

Start / End Page

1237 / 1243

Location

Netherlands

Related Subject Headings

  • Shock, Cardiogenic
  • Respiratory System
  • Myocardium
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Humans
  • Heart-Assist Devices
  • Heart Transplantation
  • Heart Failure